| Tidewater Dental Pf | |
|
690 Prince Frederick Blvd Prince Frederick MD 20678 | |
| (410) 414-8333 | |
| (301) 862-3779 |
| Full Name | Tidewater Dental Pf |
|---|---|
| Speciality | Dentist |
| Location | 690 Prince Frederick Blvd, Prince Frederick, Maryland |
| Authorized Official Name and Position | Connie M Mccabe (OFFICE MANAGER) |
| Authorized Official Contact | 3018623900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Dental Pf 690 Prince Frederick Blvd Prince Frederick MD 20678 Ph: (410) 414-8333 | Tidewater Dental Pf 690 Prince Frederick Blvd Prince Frederick MD 20678 Ph: (410) 414-8333 |
| NPI Number | 1053607002 |
|---|---|
| Provider Enumeration Date | 06/28/2011 |
| Last Update Date | 06/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053607002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6466 (Maryland) | Primary |
| 122300000X | Dentist | 14501 (Maryland) | Secondary |
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